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How to decide when doctors disagree

javajonjjavajon Posts: 2
edited 02/12/2015 - 9:30 AM in Neck Pain: Cervical
I'm a newbie here. I had extreme pain in my upper back while on an extended stay in Turkey, when symptoms included numbness in the tip of left index finger, I decided it was time to see a doctor. The Neurologist there did a physical exam in which he noted that among my other symptoms, I had extreme weakness in my left tricep. He diagnosed my condition as a herniated disc between C6-C7, which was confirmed on MRI taken that same day. I also have a much smaller herniation at C5-C6. He recommended that I see a neurosurgeon right away, advice that I ignored for about a month. After a month, the extreme pain had lessened somewhat and was manageable with 550 mg of Naproxen per day, but I went to see a respected head of physical therapy there in Turkey, after noting the tricep weakness and reviewing my MRI he said I need surgery and couldn't understand what I was waiting for. At that point I returned to the U.S. assuming I would have surgery here.
The first doctor I saw, an orthopedic surgeon who noted that much of my pain had eased, ranging from 0-4 and that the numbness in my index fingertip had almost completely disappeared and he recommended waiting to see if I continue to improve. This appointment was roughly 8 weeks since I had had peak pain 8-9. I also had another MRI done here in the States and it showed no change in the 8 week interval. I went to a neurosurgeon for a second opinion and he said there was no doubt in his mind that I needed surgery. In addition, I have reached out to friends and family connections, sharing my MRI results. One friend of a friend, a retired neurosurgeon, said I needed surgery and he thought no neurosurgeon in the country would disagree. Two other Orthopedic surgeon friends of family have independently said they would not recommend surgery unless symptoms worsened to include drop foot or loss of bladder control. The line in opinion seems to be between Neurosurgeons and Orthopedic surgeons.
I have opted to wait and have just started physical therapy and although I wouldn't trade my current relatively mild symptoms for the extreme pain I had before, my anxiety level is through the roof. Every little twinge I feel in legs or feet, is magnified in my imagination into paralysis below the waist. Lately , I have started physical therapy, including neck traction, and I have been feeling some minor pins and needles in my feet and calf muscles on a sporadic basis. The orthopedic surgeon suggested this was safe as long as they weren't prolonged, I have another appt. with him on the 24th of this month.
The tingling goes away when I walk and I am hoping it is just a function spending too much time stretched out on the couch.
I guess my questions are:
1) Who do you listen to when expert opinion is so divided?
2) Should I stop doing neck traction in physical therapy? I have heard this can be dangerous for severe herniations, although it was prescribed by the orthopedic surgeon.
3) How dangerous is it to put off surgery? The MRI shows that the herniation has closed the path for the spinal cord down to 7.5 mm at it's narrowest point.
Thank you for any advice you may have.
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Comments

  • LizLiz Posts: 7,904
    Welcome to Spine-Health

    Use that above hyperlink to help you get started with Spine-Health and navigate through the system.

    If there are any questions, you can always post them here, send Liz or myself a private message or contact Ron rdilauro@veritashealth.com

    Liz, Spine-health Moderator

    Spinal stenosis since 1995
    Lumber decompression surgery S1 L5-L3[1996]
    Cervical stenosis, so far avoided surgery
  • Looks like we have opposite predicaments. You have the significant nerve impingement neuros like to see and operate on because it is an obvious diagnosis, yet you have mild symptoms and they are urging you to operate. I however, have significant pain for 18 months and two mild herniated discs and neuros or orthos say I am not a surgical candidate and just keep giving me drugs. So strange. I would think that doctors would want to treat a patient with severe symptoms and try to give them relief. The only advice I would give you is, if your MRI is showing severe herniatiation with spinal chord compression, I would think it is better to get surgery before symptoms appear out of nowhere and are intolerable. Your nerves will heal better and quicker if they haven't been impinged for prolonged time. In my opinion it means better, quicker recovery and probably a more successful surgery. If your MRI shows such significant pathology, something silly like a violent sneeze could make all kinds of pain and problems appear out of no where. I would rather it get fixed before that happened if I was in Your shoes. Hope this advice at least gives you another perspective. Good luck and listen to your body.
  • I do remember the neurosurgeon telling me there was no rush in my case and you could be in a similar situation. He explained it this way: Disc protrusions and herniation's don't create situations that are likely to cut a nerve or starve nutrients from it. A person with a broken neck is different, the bone can cut the nerve. A person with a cancer could strangle it. I suggest that you pose the question to the neurosurgeon. Regardless the disc will never heal. The question is can you live with the discomfort area while the surrounding area is healing if it in fact does heal. How often does this thing return and how unpleasant is it.
  • How are you managing extreme pain with 550 milligrams of Naproxen? That is nothing but an anti-inflammatory, it does not affect the brain's pain center at all. Look Javajon, when I tore my ACL I had it repaired by an Orthopedic surgeon. When I tore my cervical disc at C5 I had it repaired by a Neurosurgeon.
    I bet I know which doctor prescribed the Naproxen. A little humor. :)

    In both cases I did multiple visits until I found the surgeon that I trusted and one that I thought would do a good job in the actual surgery. Stop spinning your wheels and go find yourself a good neurosurgeon that you trust to do the surgery should he recommend it.

    Fair warning to you, not all can be seen with an MRI. The spinal root is not perfectly smooth, it has grooves and bumps and branches. In my case the disc material on the spinal root was never spotted by an MRI, it was only seen in surgery. And yes, I had more than one MRI, saw plenty of Ortho's and other doctors along the way. When I finally made up my mind to see a neurosurgeon I saw three and selected one to do the actual surgery.

    The next time you see the Orthopedic surgeon ask him one simple question, does the disc itself ever heal. The answer to that my friend is no. Do you want to live like that and keep getting injections and taking pain meds or get it fixed. And it can get far worse. I went through three period of healing and back again, each one taking about six months. During the periods of healing I had no symptoms. I went back to the gym, did cycling, basketball, all that jazz. But the last period of pain was nearly intolerable and enough was finally enough. Cheers.
  • Did any of you have a nerve conduction test? I have a bulging disk at c-6-c7 (one dr.said herniated) Mri confirmed,but nerve test showed carpal tunnel in both arms, I hurt in neck.shoulder and left arm with radiating pain down to fingers.
  • It was horrible. I am not needle phobic in any way but that study was horrible and stressful. All they found in mine was radial neuropathy on my right side, my pinky and ring finger have pins and needles sensation. But the origin of the cause was not determined. The neurologist said she couldn't determine if it was coming from my neck or my elbow. Well, seeing the constant stabbing pain I have in my neck, I am deducing that it's coming from my neck!
  • I am encouraged by svbagley, that although he seems to lean toward surgery, his information is that there is no rush. My pain is relatively minimal, but my concerns are pins and needles in the feet and tricep weakness. If there is truly no rush, then I think I will give it more time, despite neurosurgeons recommendation and in line with orthopedic surgeon.

    thanks all
  • itsautonomicitsautonomic LouisianaPosts: 1,952
    Svbagley, did the doctors say the nerve root issue was missed by radiologist reading the MRI or it actually didn't show it? I am always fascinated when people say the surgeon found things during surgury not on MRI or things were much worse than MRI showed. Brings good awareness to hear other sides.
    Drg, yes I've had between 6-10 EMG/nerve conduction over last few years (can't reemeber exact). I had one show bilateral CTS but rest did not. I have read that can be false positives for carpel that actually the neck is issue. A lot about this test is skill of dr performing and reading. I had no hand issues prior to neck injury so mine was looked at as false positive and I passed all carpel tunnel manual tests
    Do your due dilegence, trust you know your body and question everything if it does not fit. Advocate for yourself and you will be suprised what will be revealed trusting your body and instinct.
  • I wish a bad reading were the case but its not, MRIs belong on the Myth Busters show.

    The spinal cord, the cord itself is where my material was. That cord has grooves, branches and bumps. My material was clumped so it appeared as one of any other bump on the spinal cord. And since it was on the outer surface the middle of the cord passed the radio waves through it just fine also.

    My surgeon shrugged, its just the way it is. The radiologist was not the only person to review the MRIs. All of the doctors did. I had three MRIs at different times and more than one primary doctor, a physiatrist and three orthopedic doctors review it. When I finally decided to see a neurosurgeon I actually had three, three neurosurgeons review it. They all said I needed surgery but no one saw the clumped material.

    Could it be found in the future with better tools, probably?
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